Ethiopian Journal of Reproductive Health

Association of preeclampsia, placental pathology, and maternal-fetal features with gestational hypertension before and after 34 weeks of pregnancy

2024-05-02T07:03:03+00:00

Objective: Evaluating the preeclampsia, placental pathology, maternal and fetal features in women with gestational hypertension (GH) at varying gestational ages.

Methods: A series of maternal, fetal, placental pathological, and neonatal variables were prospectively evaluated and compared between two 30-tuple groups of eligible pregnant women with early GH before 34 weeks' gestation and those with late GH after 34 weeks' gestation.

Results: Proteinuria and preeclampsia were more prevalent in the early GH group compared with the late GH group (80% vs 20%, P:0.001). The maternal high blood pressure and proteinuria were significantly associated with the early GH and preeclampsia (p<0.05). The percentage of syncytial knots significantly increased as preeclampsia progressed (P<0.05). A significant positive correlation existed between the early GH and the percentage of newborns admitted to NICU, the length of hospitalization, and the levels of the doppler indexes of umbilical and uterine arteries (p<0.05); the newborn Apgar scores were also lower in the early GH group (p<0.05). The mortality rate of newborns born to early hypertensive mothers (13.30%) was insignificantly higher than those delivered by the late hypertensive mothers (3.30%, p:0.16).

Conclusion: Maternal high blood pressure and proteinuria may be predicting risk factors for the early GH and/or preeclampsia. The placentas of women with early GH were partially different from those with GH after 34 weeks' gestation. Higher rates of maternal and fetal pregnancy-related complications in the early GH group may be indicative of the different effects of GH and preeclampsia on pregnancy outcomes depending on the gestational age.

Obstetric HDU: A Supply-Based Alternative for ICU Care in a Low-Income Setting: A Descriptive Study

2024-05-02T07:03:03+00:00

Abstract

Background: The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings.

Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia.

Study Design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul’s Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients’ medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results.

Results: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit.

Majority (318/355, 89.6%) from the study participants were transferred to other wards with improvement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU.

Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.

INVESTIGATING THE EFFECTS OF PAUSINYSTALIA YOHIMBE AQUEOUS LEAVES EXTRACT ON PARAMETERS FOR REPRODUCTIVE PERFORMANCE IN EXPERIMENTAL RATS

2024-05-31T12:31:51+00:00

ABSTRACT

BACKGROUND: Herbal plants and herbal preparations are widely used as immunomodulatory medicines that helps in improving reproductive health in humankind, and they are globally used and have rapidly grown in economic developmental importance.

OBJECTIVE: The study was conducted to investigate the effects of the aqueous extract of P. yohimbe leaves on sexual reproductive performance in Wistar rats. The primary outcome of the study is the reproductive performance sexual rate.

METHODS: The experimental study was carried out on albino rats of the Wistar strain, weighing between 150 and 200g sexually naive. The animals were raised in polyethylene cages and divided into four groups, which received a saline solution (control group), 2, 5, and 10 mL/kg of the aqueous extract of P. yohimbe leaves for fourteen days orally. The sexual behavior test was performed according to three types of crossing.

RESULTS: The results of the treated groups showed a significant increase in mating frequency compared to the control group. Overall, the results showed that P. yohimbe significantly affects sexual behavior. The aqueous extract of P. yohimbe leaves increased sexual behaviour and orientation activity performance recorded in the treated rats.

CONCLUSION AND RECOMMENDATION: The enhanced reproductive performance appetitive detected in the study, justify the indigenous use of the herbal plant in reproductive medicine and could be a precursor in the synthesis of useful drugs. However, based on the current findings, we recommend that careful administration be considered as a better option justifying human circumstances for patient with advanced mankind age in low dosage resource settings, as it achieves a better reproductive performance rate at a lower dose dependent increase.

Premarital sex and associated factors among unmarried students of a private college in Addis Ababa, Ethiopia

2024-05-31T13:52:10+00:00

Premarital sex may result in sexually transmitted infections (STIs) and unwanted pregnancy. Published reports on the prevalence premarital sex among private college students in Ethiopia are limited. This study aimed to assess the prevalence of premarital sex and associated factors among unmarried students of a private college in Addis Ababa, Ethiopia. A cross-sectional study was conducted and a structured questionnaire was used to collect data from 390 unmarried students of the college selected by stratified random sampling. Associations between variables were determined using logistic regression at P-value less than 0.05. The prevalence of premarital sex was 23.3%, and 20% started sex before 18. About 68% did not use condom at the first sex. Nearly 15.5% had multiple sexual partners. About 14.5% said oral contraceptive pills prevent STIs. Nearly 59 % did not have a practice of requesting a new sexual partner for STIs status. Regression analysis showed that religion, program of study, having a boyfriend or girlfriend, misconception that oral contraceptive pills protect from STIs and taking alcohol were significantly associated with having premarital sex. The prevalence of premarital was high among participants. Effective intervention strategies are needed to reduce the prevalence of premarital sex.

A retrospective analysis of maternal and pregnancy outcomes following PMTCT maternal cohort registration in a displaced setting.

2024-05-02T07:03:04+00:00

Purpose: This study assessed the maternal and pregnancy outcomes following PMTCT cohort registration.

Design: A retrospective analysis of HIV-positive pregnant women’s outcomes following enrollment in the Prevention of Mother-to-Child Transmission (PMTCT) maternal cohort register between January 2019 and December 2021 in FSP Daudu.

Method: Using a checklist, data was collected from the folders and PMTCT maternal cohort register. Measures of interest included sociodemographic characteristics, maternal outcomes, and pregnancy outcomes.

Findings: Of 223 identified HIV-positive pregnant women, 201 were enrolled in the program. However, only 189 maternal records met the inclusion criteria. Entry into the PMTCT program was mainly during the antenatal period, between 26 and 30 years of age with a mean gestational age of 15.2 weeks. Only 5.9% of the women reported facility delivery, and up to 70% had over 4 PMTCT follow-up visits before delivery (χ2 = 6.825, P = 0.03). The Retention rate among the cohort was 98.4%, with 62% of the women being active throughout the program and over 86% having a live birth. Bivariate analysis suggested that aside from maternal age, similar factors affected maternal and pregnancy outcomes.

Conclusions The active involvement and engagement of an HIV-positive pregnant woman in care can improve their health outcomes in times of displacement.

Clinical evidence: Active follow-up and documentation constitute an effective strategy to improve PMTCT maternal retention in care and improve maternal outcomes. Further support by engaging community health workers in service delivery will create positive outcomes in the PMTCT program.

Keywords: PMTCT, HIV/AIDs, Maternal health, Pregnancy.

COJOINED TWINS: SAFE TERMINATION OF PREGNANCY THROUGH DILATION AND EVACUATION AT LATER GESTATION: A CASE SERIES

2024-05-02T07:03:04+00:00

Abstract

Background: Currently, there is limited evidence on termination of pregnancy for cojoined twin documented with only 33 cases reports to-date. This study aimed to describe the clinical and procedure characteristics of second trimester dilation and evacuation(D&E) for cojoined twins at later gestation.

Methods: This retrospective case series was conducted at a tertiary-level hospital in Ethiopia from February 2023- July 2023. Women who had a cojoined twin pregnancy in later gestation (≥20 weeks) and underwent second trimester D&E were retrospectively studied through chart review. Clinical presentation, D&E procedural description, and procedure outcomes of the cases were analyzed.

Results: Three women who had a cojoined twin in later gestation (≥20 weeks) and underwent second trimester D&E were identified. In two of the cases, a two- day cervical preparation with laminaria was used to prepare the cervix while overnight Foley catheter (1-day preparation) was used for similar purpose in the third case. A cervical dilation of 3 cm was achieved in all cases and was deemed adequate to proceed with the procedure by the managing physicians. Intra-operative ultrasound guidance was utilized in all the cases and there were no complications encountered.

Conclusion: Our case series underscores the importance of achieving adequate cervical preparation, utilization of intra-operative ultrasound guidance, and handling the procedure by the most experienced provider, in increasing the safety and effectiveness of D&E procedures for conjoined twin at later gestation.

Keywords: cojoined twin, dilation and evacuation, D&E for conjoined twin, D&E for twin